title: Long-term incidence of febrile UTI after DxHA treatment of VUR.
abstract: OBJECTIVE
  To assess the long-term incidence of febrile urinary tract infection (fUTI) in children treated by endoscopic injection of dextranomer/hyaluronic acid (DxHA) for vesicoureteral reflux (VUR).
  
  
  METHODS
  Prospective study from January 2002 to December 2009 in children treated at our institution for VUR by endoscopic injection of DxHA. All children underwent clinical and renal/bladder ultrasound follow up at 3 months after procedure, then annually. Post-operative voiding cystourethrogram (VCUG) control was performed only for patients with recurrent fUTI.
  
  
  RESULTS
  227 children (177 female) were included. Mean patient age at inclusion was 4.7 years. The mean duration of follow-up was 51.6 months. During follow-up, 18.9% had one or several fUTIs, of whom 48.8% had VUR at VCUG. No recurrence of fUTI was observed after 4 years of follow-up. We identified three risk factors for fUTI recurrence: cystitis cystica at the time of injection (p = 0.007), preoperative renal scarring (p = 0.018), and the disappearance of the implant at 3-month follow-up ultrasound (p = 0.037).
  
  
  CONCLUSIONS
  The long-term incidence of recurrent fUTI after endoscopic treatment of VUR is low. Our data show that the clinical results of endoscopic treatment should be interpreted with a follow up of at least 4 years.
authors.affiliation: Department of Pediatric Surgery, Besançon University Hospital, 3 Boulevard Fleming, 25000 Besancon, France. Electronic address: afotso@chu-besancon.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fotso Kamdem
authors.affiliation: Department of Pediatric Surgery, Besançon University Hospital, 3 Boulevard Fleming, 25000 Besancon, France. Electronic address: galli.giacomo@yahoo.it.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Galli
authors.affiliation: Department of Pediatric Surgery, Besançon University Hospital, 3 Boulevard Fleming, 25000 Besancon, France. Electronic address: daubert@chu-besancon.fr.
authors.forename: Didier
authors.initials: D
authors.lastname: Aubert
mesh_terms: D019072:Antibiotic Prophylaxis; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D004724:Endoscopy; D005260:Female; D005334:Fever; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D015552:Injections, Intralesional / Q000379:methods; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000517:prevention & control; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy*
chemical_list: D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid
keywords: Dextranomer-hyaluronic acid copolymer; Endoscopic treatment; Incidence; Urinary tract infection; Vesicoureteral reflux